Digital mental health

In the UK, 38 million adults access the internet every day.1 That's 76% of the adult population. On average, internet users aged 16 and over spends more than 20 hours online each week and more than 70% have a social networking profile.2

With this growth of the internet, online spaces and smartphone apps, healthcare services are beginning to use these developing technologies to help monitor health and prevent and treat any problems. Digital health (or e-health as it's sometimes known) is a wide and varying concept that includes the use of technology for digital record keeping, online booking systems, online repeat prescriptions and some more innovative uses of technology for direct treatment.3

While applicable to physical health, there have been strides towards the use of digital health for mental health as a way to use IT to support and improve mental health, including the use of online resources, social media and smartphone applications.4 Digital mental health has been associated with benefits such as improved access to services, including online self-help and reduced barriers such as stigma.5

Evidence suggests that e-health provides the potential for reaching clients in accessible and meaningful ways.6 Although there is evidence for the effectiveness of e-mental health services, a recent study found that the majority of people are not aware of web-based therapies and that there is low awareness of e-mental health more widely.7

What is digital mental health?

Online self-help

Not everyone will feel they need or are ready to speak to someone for professional help. An alternative is to engage with some of the many online resources to allow people to engage with self-help. This could involve using information to understand mental health, using online self-management guides or using message boards or online programmes for direct support.8

Online self-help resources can be used in the privacy of your own home, on your own schedule and pace, and there is no waiting list - so they are more practical for many people.9 Your GP may be able to prescribe online self-help resources or local charities may have resources available.

Some online self-help sources do come at a cost therefore it may be helpful to speak to your GP or a professional who can advise you which sources work for which mental health problems.

E-therapy

E-therapies are programmes that use the internet or mobile devices to deliver interactive interventions for preventing and treating depression, anxiety, and other mental health problems.

E-therapies most commonly use cognitive behavioural therapy (CBT) are typically undertaken over several weeks or months. They usually involve users completing modules or exercises while receiving feedback on their progress.10,11 This type of therapy may use message boards, instant messenger with a therapist, or offer live therapy via video-calling platforms such as Skype.

E-therapies show considerable clinical benefits, especially in the treatment of depression and anxiety, and are recommended in the UK for depression and anxiety by NICE.12

Blended care

Blended care involves a combination of face-to-face treatment with online sessions. This could be online treatment sessions with structured delivery and monitoring of the core treatment information and exercises, alongside additional face-to-face sessions. In the face-to-face sessions, therapists can offer customised treatment by responding to the patient's needs, problems or wishes in real time.13

This approach is believed to be of benefit as it allows direct contact with a therapist, however the online element helps to encourage patients to take an active role in treatment that can help support the development of self-management skills.14

Online information

The Department of Health’s information strategy, which sets out the 10-year framework for transforming information for the NHS, public health and social care, notes that information must be viewed as a service in its own right.15

Research has found that over 90% of adults with internet access use search engines to find information, therefore the majority of us use online sources in some way to help us make decisions.16 Of young adults aged 18-29 who look up health information online, 33% looked up information about mental health issues, 38% looked up information on prescription or over-the-counter drugs, and 34% looked up alternative treatments or medicines.17

In addition, it has been found that those with a mental health diagnosis use the internet to search for information about their diagnosis, different treatment options and medication side effects.18 With evidence suggesting an increased demand for online health resources it is important for those supporting vulnerable individuals to ensure that the quality of online services is maintained.19

Why use digital mental health?

There at many reasons someone might want to use e-mental health services:20

  • Digital mental health resources can be available around the clock therefore can fit around your timings and schedule.
  • As services can be accessed online via a computer, smartphone or tablet, digital mental health can be used for anyone who doesn’t want to work face-to-face with a therapist, or anyone who finds it difficult to live home (i.e. because of agoraphobia or social phobia).
  • As talking therapies can often have waiting lists, these services can be used when waiting for face-to-face services. Rather than replacing traditional services, e-mental health resources can offer support during these waiting times.
  • Being online means that services can be offered to people in rural areas who may find it difficult to access services face-to-face due to long distances.
  • Online or blended approaches are likely to be cost effective, and can possibly reduce the direct costs of treatment compared to treatment as usual.

References

  1. Ofcom. (2015). Internet and online content. The Communications Market 2015.Available at: http://stakeholders.ofcom.org.uk/binaries/research/cmr/cmr15/UK_5.pdf [Accessed 01/03/16].
  2. Collin, P., Rahilly, K., Richardson, I. & Third, A. (2011). The Benefits of Social Networking Services: A literature review. Melbourne: Cooperative Research Centre for Young People, Technology and Wellbeing.
  3. Oh, H., Rizo, Carlos, R., Enkin, M., & Jadad, A. (2005). What Is eHealth (3): A Systematic Review of Published Definitions. Journal of Medical Internet Research, 7 (1):e1.
  4. Mental Health Network NHS Confederation (2013). E-mental health: what’s all the fuss about? Retrieved from: http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Docume... [accessed on: 25/11/16].
  5. Musiat, P., Goldstone, P., & Tarrier, N. (2014). Understanding the acceptability of e-mental health – attitudes and expectations towards computerised self-help treatments for mental health problems. BMC Psychiatry, 14, 109. doi: 10.1186/1471-244X-14-109.
  6. Callahan, A., & Inckle, K. (2012). Cybertherapy or psychobabble? A mixed methods study of online emotional support. British Journal of Guidance & Counselling, 40 (3), 261-78.
  7. Apolinario-Hagen, J.A., & Vehreschild, V. (2016). E-mental health – “nice to have” or “mist have”? Exploring the attitudes towards e-mental health in the general population. BMC Health Services Research 16 (Suppl 3): 200: 0119:64.
  8. NHS Choices. Online mental health services. Retrieved from http://www.nhs.uk/conditions/online-mental-health-services/Pages/introdu... [Accessed on: 25/11/16].
  9. Topolovec-Vranic, J., Mansoor, Y., Ennis, N., & Lightfoot, D. (2015). Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review. Systematic Reviews, 4: 42, DOI 10.1186/s13643-015-0032-4.
  10. Cowpertwait, L., & Clarke, D. (2013). Effectiveness of web-based psychological interventions for depression: A meta-analysis. Int J Ment Health Addiction, 11 (2), 247–268. doi: 10.1007/s11469-012-9416-z.
  11. Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev., 32 (4), 329–42. doi: 10.1016/j.cpr.2012.02.004.
  12. National Institute for Health and Care Excellence (NICE). (2006). Technology appraisal guidance 97: Computerised cognitive behaviour therapy for depression and anxiety. 2006. [2015-03-01]. Retrieved from http://www.nice.org.uk/guidance/ta97 [Accessed on: 25/11/16].
  13. Månsson, K.N.T., Skagius Ruiz, E., Gervind, E., Dahlin, M., & Andersson, G. (2013). Development and initial evaluation of an Internet-based support system for face-to-face cognitive behavior therapy: a proof of concept study. J Med Internet Res., 15, e280.
  14. Van der Zanden, R., Galindo-Garre, F., Curie, K., Kramer, J., & Cuijpers, P. (2013). Online cognitive-based intervention for depression: exploring possible circularity in mechanisms of change. Psychol Med, 44, 1159-1170.
  15. Department of Health (2012). The power of information. Putting all of us in control of the health and care information we need. Retrieved from http://webarchive.nationalarchives.gov.uk/20130802094648/https://www.gov... [Accessed on: 25/11/16].
  16. Purcell, K., Brenner, J., & Rainie, L. (2012), Search Engine Use 2012, Pew Research Center, Washington, DC.
  17. Fox, S., & Jones, S. (2009). The Social Life of Health Information. Washington, DC: Pew Internet and American Life.
  18. Khazaal, Y., Chatton, A., Cochand, S., Hoch, A., Khankarti, M. B., Khan, R., & Zullino, D. F. (2008). Internet use by patients with psychiatric disorders in search for general and medical informations. Psychiatric Quarterly, 79, 301-309.
  19. Best, P., Foye, U., Taylor, B., Hazlett, D., & Manktelow, R. (2013). Online interactive suicide support services: quality and accessibility. Mental Health Review Journal, 18 (4), 226-239.
  20. NHS Choices. Online mental health services. Retrieved from http://www.nhs.uk/conditions/online-mental-health-services/Pages/introdu... [Accessed on: 25/11/16].